Eight-year-old Leslie Marin of Burnsville flashed a toothy smile as she spoke to a University of Minnesota dental assistant about her relationship with her big sister.

“She’s into teenage stuff now,” Leslie said of 13-year-old Emily. “We only get along sometimes.”

The young patient and dental assistant were chatting on a recent Saturday morning at the U’s Moos Tower as Leslie received a comprehensive exam that included a cleaning and sealants. In an unusual twist, though, Leslie won’t be sent off with a reminder to her parents to bring her back in a year.

She’s one of about 50 uninsured Minnesota children who will be getting free preventive dental care for the next 12 months.

The U’s effort is an offshoot of the national initiative, Give Kids a Smile Day. The dental school is expanding its outreach from just one day of free dental care to 365 days, for compelling reasons.

While Medicaid covers preventive dental care for low-income children, and despite big gains in health coverage since the Affordable Care Act took effect, Minnesota still has some 400,000 uninsured people. Many are in the U’s target group — families and individuals who can’t afford private insurance but earn too much to qualify for Medicaid.

Others are turned away by dentists who won’t take Medicaid patients because reimbursement rates are low.

“If you are undocumented, you can’t access any programs. It doesn’t matter what your income is,” said Laura Peterson, a spokeswoman for Portico, a service that helps families find health insurance.

The annual aspect of the U’s program is crucial. Research, beginning with the first Surgeon General’s Report on Oral Health in 2000 to more recent findings from the Kaiser Family Foundation, shows that low-income children are less likely to get necessary preventive dental care; this can lead to higher rates of untreated cavities, missed school and punishing pain and suffering. In rare cases, children have died due to complications arising from untreated tooth decay.

“I’ve worked in really low-resource areas, areas of Appalachia to areas of Africa in Kenya, where you’re the only dentist for 500 miles,” said Dr. Elise Sarvas, a full-time faculty member in the U’s division of pediatric dentistry.

“We live in such a well-resourced area,” Sarvas said. “There are so many dentists in Minneapolis. Why are we trying to do it all in one day?

“Why don’t we spread it out so that it’s kinder to the child.”

The event has been held annually at the dental school since 2004, though limited to one day of free dental care for all children, and focused on cleanings and immediate needs. Of the 192 children served last year, some didn’t need free care, noted Taylor Sawyer, one of the program’s coordinators.

“In the past, kids were just coming on Saturdays because it was a convenient Saturday appointment,” Sawyer said.

“But it was also not the group of kids who we were trying to target.”

Care for this bull’s-eye demographic is being funded by bake sales held by dental students, grants and assistance from local organizations. Faculty, staff and students of the school also donated their services. The school will know the total cost of the care near the program’s completion next February, Sarvas said.

Trained to be calming

The event didn’t just include services for uninsured patients. The second half of the day was tailored to dental care for patients with conditions like autism. Representatives from the Holland Center, an autism center and day treatment program, said some patients have a hard time finding a dentist that’s a good fit.

“There’s a lot going on that not everybody might think about; the smells, the sounds, new people,” Sawyer, the coordinator, said. “All of our pediatric residents are also trained in behavior, so we’re all ready to go.”

Every autistic child was paired with a behavior specialist from Holland Center. Volunteer dentists had a separate training session to learn what triggers these children and what calms them down.

Leslie, who started her appointment with a medical history review and radiographs, followed by a checkup with dental assistant Hannah Lundstrom described her experience as “legendary.”

Best of all, the 8-year-old just had one cavity. Her sister, Emily, received a checkup too.

For dental students, the experience was also beneficial. Social determinants of health is a topic instilled in students throughout their studies, and reiterated by dental professionals.

“So we talk about how a tooth is important,” Sarvas said. “But that tooth is attached to a child, who’s attached to a family and a whole social situation.”

The dental students hope the children’s experience at the school will be good so that they can grow into more diligent adult patients. Being a dental patient is hard, Sarvas said, so it’s important for the students to make inviting experiences for the children all year long.

“We understand that every patient’s life extends beyond the walls of Moos Tower,” Sawyer said. “So we know there are outside factors that affect care. Whether that’s cost or preference or belief of what happens,” Sawyer said, “we understand that.”

Leslie’s father is grateful that they do.

“Honestly? This is the first time that I see her so smiley and so happy [after a dentist appointment],” Marin said of Leslie. “I guess they did a great service in here.”

Isabella Murray is a University of Minnesota student on assignment for the Star Tribune.

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